Development of Respiratory System

1. Development of Respiratory System Dr. Sanaa Alshaarawy & Dr. Saeed Vohra

2. Respiratory System • Upper respiratory tract: • Nose • Nasal cavity & paranasal sinuses • Pharynx • Lower respiratory tract: • Larynx • Trachea • Bronchi • Lungs

3. Development of the Lower Respiratory Tract • Begins to form during the 4th week of development • Begins as a median outgrowth (laryngotracheal groove) from the caudal part of the ventral wall of the primitive pharynx • The groove envaginates and forms the laryngotracheal (respiratory) diverticulum

4. A longitudinal tracheo-esophageal septum develops and divides the diverticulum into a: • Dorsal portion: primordium of the oropharynx and esophagus • Ventral portion: primordium of larynx, trachea, bronchi and lungs

5. The proximal part of the respiratory diverticulum remains tubular and forms trachea • The distal end of the diverticulum dilates to form lung bud, which divides to give rise to 2lung buds (primary bronchial buds)

6. The endoderm lining the laryngotracheal diverticulum gives rise to the: Epithelium & Glands of the respiratory tract The surrounding splanchnic mesoderm gives rise to the: Connective tissue, Cartilage& Smooth muscles of the respiratory tract

7. Development of the Larynx • The opening of the laryngotrachealdiverticuluminto the primitive foregut becomes the laryngeal orifice. • The epithelium & glands are derived from endoderm. • Laryngeal muscles & the cartilages of the larynx except Epiglottis, develop from the mesoderm of 4th & 6th pairs of pharyngeal arches.

8. Epiglottis • It develops from the caudal part of the hypopharyngeal eminence, a swelling formed by the proliferation of mesoderm in the floor of the pharynx. Growth of the larynx and epiglottis is rapid during the first three years after birth. By this time the epiglottis has reached its adult form.

9. The laryngeal epithelium proliferates rapidly resulting in temporary occlusion of the laryngeal lumen Recanalization of larynx normally occurs by the 10th week Laryngeal ventricles, vocal folds and vestibular folds are formed during recanalization.

10. Development of the Trachea • The endodermal lining of the laryngotracheal tube distal to the larynx differentiates into the epithelium and glands of the trachea and pulmonary epithelium • The cartilages, connective tissue, and muscles of the trachea are derived from the mesoderm.

11. Development of the Bronchi & Lungs • The 2 primary bronchial buds grow laterally into the pericardioperitoneal canals (part of the intraembryoniccelome), the primordia of pleural cavities • Bronchial buds divide and redivide to give the bronchial tree.

12. The right main bronchus is slightly larger than the left one and is oriented more vertically • The embryonic relationship persists in the adult. • The main bronchi subdivide into secondary and tertiary (segmental) bronchi which give rise to further branches.

13. The segmental bronchi, 10 in right lung and 8 or 9 in the left lung begin to form by the 7th week • The surrounding mesenchyme also divides. • Each segmental bronchus with its surrounding mass of mesenchyme is the primordium of a bronchopulmonary segment.

14. By 24 weeks, about 17 orders of branches have formed and respiratory bronchioles have developed. • An additional seven orders of airways develop after birth. As the lungs develop they acquire a layer of visceral pleura from splanchnic mesenchyme. The thoracic body wall becomes lined by a layer of parietal pleura derived from the somatic mesoderm.

15. Maturation of the Lungs • Maturation of lung is divided into 4 periods: • Pseudoglandular (5 - 17 weeks) • Canalicular (16 - 25 weeks) • Terminal sac (24 weeks - birth) • Alveolar (late fetal period - childhood) • These periods overlap each other because the cranial segments of the lungs mature faster than the caudal ones.

16. Pseudoglandular Period (5-17 weeks) • Developing lungs somewhat resembles an exocrine gland during this period. • By 17 weeks all major elements of the lung have formed except those involved with gas exchange. • Respiration is NOT possible • Fetuses born during this period are unable to survive.

17. Canalicular Period (16-25 weeks) • Lung tissue becomes highly vascular. • Lumina of bronchi and terminal bronchioles become larger. • By 24 weeks each terminal bronchiole has given rise to two or more respiratory bronchioles • The respiratory bronchioles divide into 3 to 6 tubular passages called alveolar ducts. • Some thin-walled terminal sacs (primordial alveoli) developeat the end of respiratory bronchioles. • Respiration is possible at the end of this period. • Fetus born at the end of this period may survive if given intensive care (but usually die because of the immaturity of respiratory as well as other systems)

18. Terminal Sac Period (24 weeks - birth) • Many more terminal sacs develop. • Their epithelium becomes very thin. • Capillaries begin to bulge into developing alveoli. • The epithelial cells of the alveoli and the endothelial cells of the capillaries come in intimate contact and establish the blood-air barrier. • Adequate gas exchange can occur which allows the prematurely born fetus to survive

19. By 24 weeks, the terminal sacs are lined by: • Squamous type I pneumocytes and • Rounded secretory, type II pneumocytes, that secrete a mixture of phospholipids called surfactant. • Surfactant production begins by 20 weeks and increases during the terminal stages of pregnancy. • Sufficient terminal sacs,pulmonary vasculature and surfactant are present to permit survival of a prematurely born infants • Fetuses born prematurely at 24-26 weeks may suffer from respiratory distress due to surfactant deficiency but may survive if given intensive care.

20. Alveolar Period (32 weeks – 8 years) • At the beginning of the alveolar period, each respiratory bronchiole terminates in a cluster of thin-walled terminal saccules, separated from one another by loose connective tissue. • These terminal sacculesrepresentfuture alveolar sacs. • The epithelial lining of the terminal sacs attenuates to an extremely thin squamous epithelial layer.

21. Characteristic mature alveoli do not form until after birth. 95% of alveoli develop postnatally. • About 50 million alveoli, one sixth of the adult number are present in the lungs of a full-term newborn infant. • From 3-8 yearor so, the number of immature alveoli continues to increase. Unlike mature alveoli, immature alveoli have the potential for forming additional primordial alveoli. • By about the eighth year, the adult complement of 300 million alveoli is present. • Most increase in the size of the lungs results from an increase in the number of respiratory bronchioles and primordial alveoli. rather than from an increase in the size of the alveoli.

22. Breathing Movements Occur before birth, are not continuous and increase as the time of delivery approaches. Help in conditioning the respiratory muscles. Stimulate lung development and are essential for normal lung development. • Lungs at birth • The lungs are half filled with fluid derived from the amniotic fluid and from the lungs & tracheal glands. • This fluid in the lungs is cleared at birth: by: • Pressure on the fetal thorax during delivery. • Absorption into the pulmonary capillaries and lymphatics. • Lungs of a Newborn • Fresh healthy lung always contains some air (lungs float in water). Diseased lung may contain some fluid and may not float (may sink). Lungs of a stillborn infant are firm, contain fluid and may sink in water.

23. Developmental anomalies • Laryngeal tresia. • Tracheoesophageal fistula. • Tracheal stenosis & atresia. • Congenital lung cysts. • Agenesis of lungs. • Lung hypoplasia. • Accessory lungs. Factors important for normal lung development • Adequate thoracic space for lung growth. • Fetal breathing movements. • Adequate amniotic fluid volume.

24. Tracheoesophageal Fistula • An abnormal passage between the trachea and esophagus. • Results from incomplete division of the cranial part of the foregut into respiratory and esophageal parts. • Occurs once in 3000 to 4500 live births. • Most affected infants are males. • In more than 85% of cases, the fistula is associated with esophageal atresia.

25. Thank You & Good Luck